Common Reasons for Denial

• An initial Certificate of Medical Necessity (CMN) or DME Information Form (DIF) was not submitted with claim or on file with Noridian

Next Step

• Resubmit claim with CMN or DIF if one is not on file
• A self service reopening in the Noridian Medicare Portal may be conducted if CMN or DIF is now on file with Noridian. This can be verified on the Noridian Medicare Portal under the Same or Similar function
• Did your CMN/DIF get accepted when billed through the electronic transmission? If the front end acknowledgement reports from the electronic transmission with CEDI are not worked by supplier staff or clearinghouse, the CMN/DIF may not have been received by Noridian with the claim.
• A Redetermination request may be submitted with all relevant supporting documentation. Noridian encourages Redeterminations/Appeals be submitted using the Noridian Medicare Portal. Review applicable Local Coverage Determination (LCD), LCD Policy Article, and Documentation Checklists prior to submitting request. Noridian encourages Redeterminations be submitted using the Noridian Medicare Portal

How to Avoid Future Denials

• To verify a CMN or DIF is required, refer to applicable Local Coverage Determination (LCD), LCD Policy Article
• For proper claims processing, attach initial CMN or DIF to claim
  • Supplier must submit initial CMN or DIF for item billed
• If an initial CMN or DIF is posted to Common Working File (CWF) under another jurisdiction, include a comment on claim
• Ensure all the front end acknowledgement reports from the electronic transmission with CEDI are worked by supplier staff or clearinghouse, to ensure the CMN/DIF is put on file